16667 • POST THIS,CARD NEAR FRONT OF BUILDING
•'
PERMIT NUMBER.
CITY OF CUPERTINO., 16667
INSPECTION DIVISION
JOB INSPECTION RECORD"
PERMIT EXPIRATION .i
/ // Q -
' 'JOB ADDRESS l �s �"' 7K- d'e-�'�G •C7 - UNIT# -LOT#'
/� � L� PERMIT I EXPIRES IF WORK`.'?
OWNER �L �/ / 61� U CONTRACTOR �- Z G. c—���. �X G. IS NOT STARTED WITHIN
INSPECTION DAT INSPECTOR INSPECTION RECORD tao onus oFPERMIT isSu-j
' ,
FOUNDATION, - } NOTE: • ',
A!— OR 180DAYS FROM.'
LIFER 'Z .8 4l ALL GRADING AND DRAINAGE SHALL•BE�'INSTALLED LAST CALLED INSPECTION..
PREGUNITE TO COMPLY WITH THE APPROVED PLANS AND CIN OF PERMIT VALIDATION
CUPERTINO STANDARDS'
GARAGESLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED - '/ - wl. .• " '
UNDERGROUND /SLAB' ,
PLUMBING
ELECTRICAL- - - - ISSUANCE DATE - r
MECHANICAL - - BLDN ELECT. ,PLCO MECH:•
ElR ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT{{
WOOD FLOOR - INFORMATION 'Z j
LUA ON��I, $/FT. I
PLUMBING
j
- k
MECHANICAL '•c ! \"
_ Yw' PeRMIT TO
ELECTRICAL . . +// D
FRAMING .I(� �� I
INSULATION, --STORIESSTR.
STORIES TYPE
A.
�•�7 ICC.GROUP S.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -
SO.FT,FLOORAREA .TOTAL ACREAGE
.� ROOF ,+• _ NOTE NO FINAL-INSP.SHALL BE MADE BEFORE
DIAPHRAGM - - THE CONSTRUCTION TAX IS PAID
' BUILDING USE
' ROOF SHEATHING - , .RES IND LON PB O
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS ;DATE INSP. ❑ ❑ .' ❑ ❑
ASSESSORS PARCEL NO.
ROUGH SANY
PLUMBING ELECT.ENERGY
TUBS&SHOWER PAN ' - PLUMBING ENERGY' TRACI NU... PARCEL NO,
MECHANICAL MECH.ENERGY , '
. ACC.SALE ACC.FILE N0." •
ELECTRICAL -. `3- AUT( BUILDING ENERGY.
FRAMING 3:)•_ ELECT.FINAL-TEST -
INSULATION - PLUMBING, - ZONING .ENG,SITE NO. T
GAS TEST % GAS- 7 ,
1 ' FIRE$PRINK ENE0 T
MECHANICAL •
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ° ❑ N❑ -❑• _N�
EXTERI OR'SHEAR ELECTRICAL RELEASE FLOOD 10NE A.I.,LLCI - I
INTERIOR SHEAR IIA ,Q , FIRE DEPT. YEJ 'N C] . ❑'''N❑'
SHEETROCK GRADE FEE SUMMARY
EXTERIOR LATH g BUILDING 'BUILDING
INTERIOR LATH_ TEMPORARY APPROVALS
SCRATCH COAT - ELECTRIC - PLAN CHECK„
FEE
. GAS. "
NO TAPE-OR PLASTER UNTIL ABOVE HAS BEEN-SIGNED' OCCUPANCY - seisMlc FEE
OCCUPANCY OF BUILDING IS NOTPERMITTED UNTI L BUI LDING FINAL IS SIGNED BY BUI LDING'INSPECTOR. 'MICROFILM
ARRANGE FOR INSPECTION BY-"PHONING 252-4505, ELECTRIC qAIL- ,
614,
H ONE WORKING DAY BEFORE REQUIRED INSPECTION:. ' PLUMBINvG '
O�. PLEASE GIVE JOB ADDRESS_WHEN PHONING. .
_ z - MECHANICAL
' - SEE PERMIT FOR.EXPIRATION DATE — _
IMPORTANT!, conisr.rnx
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL'INSPECTION.
OFFICE COPY i .
APPLICANT TO FILL IN INFORMATION WITHIN,RED LINES - USE BALL POINT PEN ONLY
. • lo - BUILDING PROJECT IDENTI FI2aTION - - - vERMlr NUMBER -
AJILDINe!
ADDRESS _ APPLICATION & PERMIT (;,�,�]
`r 1.
Lis 10 BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
• CANER'5 - - „ PLAN CHECK VALIDATION
rvamE .CITY. ELECTRIC PERMIT - FEE
PNON
CO.Tff.ICTOR S rOUTLETS-SWITCHES-RECEP 10.00/1.00
NAME p
E��� / i. %uc.No GHTINGFIXTURES' I 10.00/1.00
CONTRACTORS w 1 :� Ilny� ,J ��J PPCIANCES>RESIDENTIAL 4.00 „
ONE Jy-%�4 - PANELS 10.00 OATE OFAPPLICATION
Rc„rtecr - PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.0.NO.
O
OR
ENGINEER o
LIC:NO. • SIGNS TRANS. 3.00 n
AARC MOR DDRESS ENG_ SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ZIP TEMP.METER R POLE INS. 20.00 (�
APPLICANT'S
AooREss - MOTORS SEE FEE SCH.
• , a'� irG�60c /: Shn✓1 r , SERVICIECHANGE - '.20.00 9a per/
w o o. LICI?N$ED CON'1'RAM CBS DECLARATION
a C u Thereby uffirn'0]at 1 aC licensed under provixiolrs ,I Chapter 9 ]- - Q$$UANGE DATE .t
(commencing with Section 7000)of Division 3'o1 the Busiress and _ p ELECT. I PLO MECH.
.� i Professions Cole nd in lice...`.is in full fort- d � ''x'"
Z 0 m - License Clus ! Lie.Number- El
EJ
❑'.
o H o Date } iContmcmr .
`a
as
s BUILDING PERMIT
¢ ¢.w c - OWNER-BUILDER DECLARATION.' •6 v"
K o a ° , MISC: '.' • REFER TO ORD INFORMATION
w3 u-y I hereby affirm that 1 am exempt from the Contractor's License -- -
u o ¢ Low lot the f(lowing reason.(Sec 7031.5,Businesxwfd Professions PERMIT ISSUANCE '.10.00 O - VALUATION $/FT.
w as �` Code;Any city or county which requires permit to construct,almq
SE SC Q Q improve;demolis ,hor repair any structure,prior to its issuance,also ELEC.CONTR.' LIC.NO. ELEC.
- O¢ requires life applicant for such permit to file a signed statement tlta� TOTAL PERMIT TO -
• he is licensed pursuant to tlfe DoWhions of the Contractor's License
H z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe / SSL
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT 'FEE
¢I o the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
a ;m by any applicant for a fiction objects the applicant fm a civil penalty ALTER-DRAIN& VENT-WATER.IEA.) 5.00
m
Ofhot.....re than five hundred dollars($5000.): ` 'j
❑v I,as owner of the property,or y employees with wages as BACKFLOW PROTECT.DEVICE ' 4.00 OCCGRDUP RES.uN1T5
their sole com .compensation,will Jo 0]e work,and the is not ,
intended or offered for Sale (Sec. 7044. Business and Professions DRAINS'-.FLOOR„ROOF,AREA,COND. 5.00 "
Code:The Contractor's License Law does not apply to an owner of
property who builds or i...prove,Iherumn,and who does such work FIXTURES,PER TRAP 5.00 SO,IT,FLOOR AREA TOTAL ACREAGE
himself or through his own emphiyees,provided that such improve- - 's
menu are nut intended or til fereJfor sale.If,however,the budding GAS-EA.SYSTEM-11NC.4OUTLETS 6.00
or nnpnrvemeat is.old within o L year of iompl Hen 11 a own 11- GAS-EA.SYSTEM--OVER 4 (EA.) 2.00 BUILDING USE
builder will have theburden of pr] my that liedid not build or inr RES IND CON PB :Omer
prove for purpose of sal .). INDUSTRIAL WASTE INTER: 30.00 ❑ ❑. .❑ 1:1 ' ❑
❑ I,as owner of the properly ran exclusivLly contracting with -
licensed contractors to construct fine project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. s 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contract.,',License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractods)licensed pursuant to • SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO. PARCEL NO.
❑' Iman exen.ptunder Sec.' �'.BA P.C.tbnthis WATER HEATER,W/VENT 6.00
reason
Owner DaleWATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
-WORK ERS'CONPF.NSA'I'ION DECLARATION WATER TREATING EQUIP, - 5.00
I hereby affirm lhaol have a certificate of consent to self-instire. - f" ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insuranec, certified
COPY th¢col(Sec 3800,Lub.C. 6✓fie 7- -
PolicyNo. 'LOmPI � ` SAS fT•2 .. - •. ..
Q ❑ CcrlilicJ co is her ylvniSsJ-]:' _ FIRE SPRINK ENERGY TR4
Z Z Certlfl' e y I I'yI with �d�iw�
MISC.- - REFER TO ORD. ;O Applicant ,. v❑ N❑ v ❑ N❑
CCNCER'IICATEOP EXENIpTION FRo •PERMIT ISSUANCE _ ,10.00 FLOOD ZONE A.L.U.C.
Ill >_ - COMPENSATION INSURANCE" PLG CONTR.- LIC.NO. PLG.
d 0 ,(Chis vatin, need not be completed if the,permit is I'or one - TOTAL _ v❑ N❑ Y ❑ N❑
D Z hundred dollar-s(SI00)or le,,.) +-- ' - - -.
U O Lcertify.that in the performance ol',the work for which this Der- CITY. t MECHANICAL PERMIT FEE FEE SUMMARY
LL H mitis issued,1 shall not employ Sly Person in any Canner so as to
O w become subject to the Workers'Compensation Laws of California. _ - BUILDING
Date-Applicant - - ALTER OR ADD TO MECH. 5.00
} N NOTICE'10 APPLICANT: If,after making this Certificate of Ex-
F Z emptier,you should become subject,to the Workeri Compensation APPLIANCE ` _ 5.00 PLAN CHECK
provisions of the Labor Code. you must forthwith cdnn Ply will] �FEE -
U such provisions or this permit shall be deemed revoked. ti 'AIR:HANDLI INC UNIT(TO 10,000GF.M.) 4.00
CON51'RUCTION LENDING AGIiNCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affil-in that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which(his permit is issued(Sec. _ MICROFILM
3097.Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00_
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC A�
Lender's Address"
I certify thutlhuve read this':application uno state that the above VENTILATION'FAN (SINGLE) 4.00 '
information is state. I agree m g toPb with all city and county a BOILER-COMP( H.P.O}100;000 B.T.U.) 6.00 PLUMBING _
ordinances and state laws refining to building co rslrucl ion, any -
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100.000BTUISEE FEESCH. MECHANICAL
above nuentioned property for inspection purposes,
(We) agree to Save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against li ili(ies,judgments, Costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may in any way accrue Pgain,I "id Cily in,consequence of the
run
tin,of this n i1. 7f MECH.CONT. -LIC.NO. MECH. )
TOTAL ' TOTAL . 4�
Signa of Applicant/Contractor V Dalt.+ -
OFFICE COPY